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��_ CITY OF DIAMOND BAR / ,
DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES Y i
;,, 21825 Copley Drive,Diamond Bar,CA 91765 ��
(909)839-7020 Fax(909)861-3ll7 Building Inspec���rSg(����027 r PRESS
�''"',W BUILDING PERMIT APPLICATION � FIRMLY
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APN LOT RACT DATE ��'�I���O CONST. �(/�-�RpUP
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� CITY . ZIP TEL.��- � �..� PROPOSED USE �� n��
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Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AA/E%EMPT FROM THE CONTRACTORS ll- G8f8gB/CBfpOff
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n
C� COUNTYWMICHREOUIRESAVERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTqUC� W P8�I0/DBCI( .
< TURE,PRIOR TO ITS ISSUANCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w
� STATEMENT THAT HE OR SHE IS IJCENSED PURSUANT TO THE PROVISIONS OF THE CONiRACTORS LI�
� CENSE UW(piAPTER e(COMMENCINO WITH SECTKKJ 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u' POOUSPB
, � FE9SqNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEGED E%EMP- �
TION.ANY VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT 5U&IECTS THE APPLICANT T0 Z Re-Roof
� A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLAAS(f500).):
� ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIqSOLECOMPENSATION, 0 Commercial
Z WILL DO THE WORN,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701a,BUSI- J
N NESS AND VROFESSIONS CODE:7HE CANTRACTORS UCENSE UW DOES NOT APPLY TO AN OWNER OF �
PROPEHTY NM1iO BUttDS OR IMPROVES THEREON,M1D WHOOOES SUCH WORK HIMSELF OR HEqSELF OR
Q TNROUGH HIS OR HER OWN EAIPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
Q OFFEqEDFORSALEIF,HOWEVERTMEBULLDINOORIM7ROVEAIENTIS50LDWITMNONEVEAROFCAMPLE�
Z TqN,THE OWNER-BUILDER WILL HAVE THE BUfiDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
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❑I,AS OWNER OF THE PROPER7Y.AM EXCLUSIVELV CONTRACTINO WRH UCENSED CONTRACTOi15
(= TO CANSTRUCT THE PRQIECT(SEC.7011,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V8W8110l1 ADJ.AREA
W CENSE UW OOES NOTAPPLV TO AN ONRJER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON.AND
� WFIOCONTRACTSFORSUCliPROJECTSWITHACONTRACTOH(5)UCENSEDPURSUANTTOTHECONTRAG QunNnTr DESCRIPTION FEE
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0 ❑I AM E%EMPT UNDEF SEC. B.8 P.C.FOR THIS REASON Q
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� OATE ONTJER �
� LICENSED CONTFACTORS DECLARATION w
� I NEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM IICENSED UNDER PROVISIONS OF CHAPTER �
� D(COMMENCINO WfTH SECTION 7000)OF DIVISKKJ 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
��� MV LICENSE IS W FULL FORCE ANO EFFECT. m
� LICENSE CLASS C`\) LIC.NO. � �
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� WORKERS'COMPENSATION DECLA T N ' ("t�� Q
� I HEREBY AFFIRM UNDER PENALTV OF PERIUqY ONE OF THE FOLLOWING DECLARATIONSv � �
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� _I NAVE AND WILL MAINTAIN A GERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' ¢
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COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOH THE PERFORMANCE U
OF THE WORK FOR WHIC}1 THIS PERMIT IS ISSUED. W
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w _I HAVE AND WILL MAINTAIN WOR)(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV NqRKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
jCARRIER PLAN REVIEW
POLICY NUMBER
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� (trflssEcrannE�raiee�.s�ErEooFn�EVEp.rr�swaprgrn�ronEppp1aasK,ro�pq�ss} PLUMBING
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHlpi iHIS PERMIT IS ISSUED,I MECHANICAL
CS SHALL NOT EMFLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(/) WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORNERS'COM7ENSATqN PROVISIONS OF SECTION 3700 OF THE LABOR
S CODE,I SHALL FOqTHWITH COMPLV WI TH SE PROVISIONS. UA ��Q O
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p DATE: APPLICANT:
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J WARNINO:FAIWRE TO SECURE M/ORKERS'CAMPENS ON VERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � �
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� SU&IECTAN EMPLOVEN TO CRIMINAL PENALTIES AND VIL FI S UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOU.ARS(5100,000),IN IDDITION TO THE COST OF CAM S ON.DAMAOES AS PROVIDED FOR IN
� J SECTION 3708 OF 7HE LABOR CODE,INTEREST,AND ATTO S FEES.
w � ' ETENTION F • �D(�
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
,� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS AC07JSTRUCTION LENDINQ AGENCV
FOR THE PERf-0RMANCE OF THE WORK FOR WFIICH THIS PERAl1T IS ISSUED(SEC.3oe7,CIV.C.�.
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� LENDER'S NAME
� IENDER'SADDRE55
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT 7HE ABOVE INFORMATION IS CARqECT. TOTAL FE ES �6.�O
� I AGREE TO COMPLV WITH ALL CfTV AND CWNTV ORDINANCES AND STATE UWS REUTIN6 TO BUILDIN6
� CANSTRUCTION,ANOHEREBYAUTHORIZEREPRESENTATIVESOFTHISCWNTVTOENTERUPONTHE
Z ABOVE-MENTqNED PROPERTV FOR INSPFCTION PURPOSES. COMMENTS '
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� RECPT.N0. � PAID BY �-K� VAUDATION
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND d UNDER FLOOR DUCT
GROUNO PLUMBING UNDER FLOOR CONDUIT
SLAB GRAOE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING ' 8 FT. BOND BEAM - �
FRAMINGNENTILATION F1NAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC � � ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWEA FINAL ENG.
SEPTIC TANK LANDSCAPE/)RRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC J�J-ISi'J DEV. FEES PAID
FINAL PLUMBING ENERGY �
C�'1 OO(�o c
COMMEfVTS �
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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